Dr. Hitesh Kumar
Neurology
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Patient's Query
Hi doctor,
I have a problem with headaches. It pains at back of head all around and upper head too sometimes. Headaches are constant all day, and I am having this for a year now. I got an MRI done as well. I will attach the results here. I have a problem with sleep since long time and it seems headaches are because if that.
Within an hour of sleep I woke up like jumping out of bed with force. Sometime it seems like somebody came in and I am looking for it, turning lights on, literally running. After 30-40 seconds I realize that I woke up from bed and nothing here. But I do not think it is a dream.
The way I get up is not normal so my whole body gets disturbed and head specifically. Let us say if somebody sitting in a car and other car hit from back unknowingly how the body and head fall apart. This happens to me. I did not had headache ever before, it started with this sleep problem.The sleep doctor said I do not have sleep apnea. I tried a neurologist but is not working out.
Hello,
Welcome to icliniq.com.
I would like to know some further details about your headache.
Since when you started to have these headaches? Do they started from 1 year only? Or used to occur before also intermittently? If yes, since when? What kind of headaches you feel at back of head and upper head heaviness, bursting, squeezing, stretching, throbbing, or some other kind? How is the intensity of headaches, mild, moderate, or severe?
Is your headaches persistent same intensity 24x7? Or it is intermittent or have variable intensities? If intermittent, one episode of headache lasts for how long duration (without pain killer tablet)? Do you feel any nausea or vomiting during headache episode or during increased intensity headache? Is headache associated with any redness in eyes, watering from eyes, or nasal blockage? Have you noticed any specific trigger factor, timing for this headache until now? If it is of variable intensities, how frequent are severe intensity headaches? How many times in a week/ day? For how long time you taken tablet Amitryptiline for your headaches? And in what dosage? Did you had some betterment in headache on that medicine? How is your vision for distant objects or for near objects?
Other information: Since when you have sleep disturbance? How is your sleep in routine? Do you get sleepy soon after laying in bed? Or it takes long time? Once got sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in morning? Do you take tablet Zaleplon daily?
How is your usual mood in day today activities? Happy/ toward sad side (thinking about past events), toward worried side (thinking about future things? How is your appetite?
Investigations to be done
Differential diagnosis
Regarding follow up
Patient's Query
Thank you doctor,
I never had headaches before, first time it could be year back or so. It started with little warm in back. I have headache mostly in back of head. It is getting warm so many times. Lately I notice whenever I am invloving in heated arguments or something back of head get hotter. I feel heaviness in morning, squeezing sometime, but it is there pretty constant pain in back of head. Sometime tightness and dizziness kind of headache. The intensity varies from severe to mild.
It stay for all day even the second day as well. I assume my sleep disturbance is causing the problem. I do not feel any nausea or vomiting during headache episode or during increased intensity headache. And my headche is not associated with any redness in eyes, watering from eyes, or nasal blockage. It starts mostly in the morning and I get this pain at least three days a week.
I took tablet Amitryptiline for three months or so. I started with Prednisone which made good effect but not treating the cause. But sometime later it did not work, so my doctor changed it to Nortriptyline HCl 25 mg, 50 mg, it was not working so changed to Topiramate 100 mg, then to propranolol, and last was Verapamil 80 mg.
For all above, I had some or other symptoms like suddenly I have shortness of breath (I take inhaler when needed I have asthma), uncomfortable, stomach problem, etc. For Verapamil, I was feeling too hot inside my body and frequency of waking up in night suddenly increase. I got vision tested today, it is normal 20/20. Doctor checked the nerve and said it does not having any swelling or something which could cause headaches. No need of prescription at this point.
Other information:
I have sleep disturbance for more than 8-10 years now. Earlier, I used to get up once in a while and then gradually it has increased. I do sleep soon as 20-30 minutes after lying down, it never took long time. I noticed I woke up exactly at 30 minutes after I got to sleep. Lately, it has increased to two to three times then again once every night. Thing is the way I wake up, I literally jump out of bed. Usually people get up from bed with a little turning in their body. I wake up straight with tremendous force and I run and look here and there for something, turn on the lights, go to other room literally running.
I am scared kind of at that time, sometime following the dream like someone came in the room and I am looking under the bed, sometime it seems like any small insect or things like that. This is not every time though same kind, but I woke up first time usually right at 30 minutes, for 20-30-40 seconds. I do not know whats going on, then I come back to my consciousness and realize I woke up in night.
I did my home and lab sleep study but I do not have sleep apnea. Sleep doctor do not want to give me any medicine because she believe I do not have sleep issues. Later, I insisted on giving me some medicine due to too much sleep problem she gave me Zaleplon. It is not working much but maybe helping a little.
My mood lately got more irritable because of all this thing, never woke up fresh and just dragging myself. I think a lot too. My appetite is good, it may differ sometime due to medicine side effect else is good. I had some stomach problem for few years, I did endoscopy and colonoscopy too, but now I do not have any stomach problem.
Hello,
Welcome back to iclinniq.com.
As per your information, your headache does not seem to be of migraine headache and you had no clinical benefit by medicines Propranolol, Topiramate, and Verapamil.
Your MRI brain also not showing any significant thing.
Possibly it can be tension type headache associated with secondary anxiety and mood irritability.
Investigations to be done
Differential diagnosis
Probable diagnosis
Treatment plan
Preventive measures
Regarding follow up
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Neurology
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